Health Care Institutions Volume Is Significantly Associated with Postoperative Outcomes in Bariatric Surgery.

Abstract

The volume of bariatric surgery has significantly increased over the past decade with concomitant postoperative outcomes improvement. The goal of this nationwide study was to estimate the volume-outcome relationship in bariatric surgery at the hospital level. A cross-sectional analysis of all patients who underwent bariatric surgery procedure in France from January 2011 to December 2014 was designed. Volume-outcome relationship was analyzed using generalized estimating equations. We identified 184,332 inpatient stays for bariatric surgical procedures performed in 606 hospitals. Health care institutions performing more than 200 bariatric cases per year were significantly associated with shorter average length of stay (p<0.001) and less frequent need for intensive or critical care unit (p=0.003) during the index stay in comparison with lower volume institutions. Reoperations rate increased from 3.1% [95% CI, 2.8-3.3] (n=5627) at 1month to 4.9% [4.6-5.2] at 3months and 8.2% [7.8-8.7] at 6months. The risk of reoperation after gastric bypass was 1.37 times less frequent in higher volume institutions (≥200 inpatient stays per year, p=0.003), while it was 1.26 times more frequent after gastric banding in higher volume institutions (p=0.057) and was unaltered regarding sleeve gastrectomy (p=0.819). This study showed for the first time in bariatric surgery that reoperation rate after gastric bypass or sleeve significantly increased at 3 and 6months postoperatively. Health care institutions performing more than 200 bariatric cases per year were significantly associated with improved postoperative outcomes and less frequent need for reoperation.